Up to 40 percent of older persons who drink may be at-risk for harm. This risk is due to age-related physiological changes that increase the effects of a given dose of alcohol and age-associated increases in comorbidity and medication use that may cause adverse effects when even small amounts of alcohol are consumed. Most trials of brief advice to reduce drinking among primarily younger populations have reduced subjects' alcohol use by 10-20 percent. These trials have focused on drinkers who are at risk because of the amount they drink, or because they have symptoms of alcohol abuse or dependence. No trials have yet focused on older drinkers who are at risk because of the interaction of alcohol use and co-morbidity (e.g., diabetes, hypertension) and medication use (e.g., anticoagulants, nonprescription antihistamines). To test whether a screening and brief advice preventive intervention targeted to older persons may reduce such at-risk drinking and prevent subsequent harm, we propose a 12-month, randomized, controlled trial involving 880 subjects attending primary care clinics at two non-academic sites. Our intervention will consist of advice given to both at-risk drinkers and their physicians personalized to address the particular reasons a subject is identified as an at-risk drinker. We will identify at-risk drinkers using a new screening measure, the Short Alcohol-Related Problems Survey (shARPS). Respondents may be identified as at-risk drinkers because they have a single risk (e.g., drinking and using benzodiazepines) or multiple risks (e.g., drinking and using narcotics, drinking and having depression). At-risk drinkers will be randomized to either receive brief advice about at-risk drinking (intervention) or a booklet on healthy behaviors (control). To assess the efficacy of the intervention, subjects will undergo assessments of their alcohol-associated risks at recruitment, and 3 and 12 months later. Our analyses will assess the effect of the intervention on the prevalence of at-risk drinking, the amount of drinking, and the numbers of risks identifying those subjects still considered at-risk drinkers. This study will be the first to assess a preventive intervention to reduce risks of alcohol use, alone or in conjunction with comorbidity and medication use among older adults in primary care. If such an intervention is successful, potentially hundreds of thousands of older persons may benefit from a reduction in their risks associated with alcohol use and prevention of harm.
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